Healthcare Provider Details

I. General information

NPI: 1205615317
Provider Name (Legal Business Name): SHELLEY B GREENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY H BRANNON

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 COTTAGE HILL RD STE 400
MOBILE AL
36606-2913
US

IV. Provider business mailing address

2764 BREVARD DR
MOBILE AL
36606-2235
US

V. Phone/Fax

Practice location:
  • Phone: 251-235-2531
  • Fax:
Mailing address:
  • Phone: 334-437-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75796
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-208301
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: